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Starčuková J, Stefan D, Graveron-Demilly D. Quantification of short echo time MRS signals with improved version of QUantitation based on quantum ESTimation algorithm. NMR IN BIOMEDICINE 2023; 36:e5008. [PMID: 37539457 DOI: 10.1002/nbm.5008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
Magnetic resonance spectroscopy offers information about metabolite changes in the organism, which can be used in diagnosis. While short echo time proton spectra exhibit more distinguishable metabolites compared with proton spectra acquired with long echo times, their quantification (and providing estimates of metabolite concentrations) is more challenging. They are hampered by a background signal, which originates mainly from macromolecules (MM) and mobile lipids. An improved version of the quantification algorithm QUantitation based on quantum ESTimation (QUEST), with MM prior knowledge (QUEST-MM), dedicated to proton signals and invoking appropriate prior knowledge on MM, is proposed and tested. From a single acquisition, it enables better metabolite quantification, automatic estimation of the background, and additional automatic quantification of MM components, thus improving its applicability in the clinic. The proposed algorithm may facilitate studies that involve patients with pathological MM in the brain. QUEST-MM and three QUEST-based strategies for quantifying short echo time signals are compared in terms of bias-variance trade-off and Cramér-Rao lower bound estimates. The performances of the methods are evaluated through extensive Monte Carlo studies. In particular, the histograms of the metabolite and MM amplitude distributions demonstrate the performances of the estimators. They showed that QUEST-MM works better than QUEST (Subtract approach) and is a good alternative to QUEST when measured MM signal is unavailable or unsuitable. Quantification with QUEST-MM is shown for 1 H in vivo rat brain signals obtained with the SPECIAL pulse sequence at 9.4 T, and human brain signals obtained, respectively, with STEAM at 4 T and PRESS at 3 T. QUEST-MM is implemented in jMRUI and will be available for public use from version 7.1.
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Affiliation(s)
- Jana Starčuková
- Institute of Scientific Instruments of the CAS, Brno, Czech Republic
| | | | - Danielle Graveron-Demilly
- D1Si, Saint André de Corcy, France
- CREATIS, CNRS UMR 5220, INSERM U1294, Université Claude Bernard Lyon 1, Villeurbanne, France
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McGee KP, Hwang KP, Sullivan DC, Kurhanewicz J, Hu Y, Wang J, Li W, Debbins J, Paulson E, Olsen JR, Hua CH, Warner L, Ma D, Moros E, Tyagi N, Chung C. Magnetic resonance biomarkers in radiation oncology: The report of AAPM Task Group 294. Med Phys 2021; 48:e697-e732. [PMID: 33864283 PMCID: PMC8361924 DOI: 10.1002/mp.14884] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 12/16/2022] Open
Abstract
A magnetic resonance (MR) biologic marker (biomarker) is a measurable quantitative characteristic that is an indicator of normal biological and pathogenetic processes or a response to therapeutic intervention derived from the MR imaging process. There is significant potential for MR biomarkers to facilitate personalized approaches to cancer care through more precise disease targeting by quantifying normal versus pathologic tissue function as well as toxicity to both radiation and chemotherapy. Both of which have the potential to increase the therapeutic ratio and provide earlier, more accurate monitoring of treatment response. The ongoing integration of MR into routine clinical radiation therapy (RT) planning and the development of MR guided radiation therapy systems is providing new opportunities for MR biomarkers to personalize and improve clinical outcomes. Their appropriate use, however, must be based on knowledge of the physical origin of the biomarker signal, the relationship to the underlying biological processes, and their strengths and limitations. The purpose of this report is to provide an educational resource describing MR biomarkers, the techniques used to quantify them, their strengths and weakness within the context of their application to radiation oncology so as to ensure their appropriate use and application within this field.
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Affiliation(s)
- Kiaran P McGee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ken-Pin Hwang
- Department of Imaging Physics, Division of Diagnostic Imaging, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Daniel C Sullivan
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - John Kurhanewicz
- Department of Radiology, University of California, San Francisco, California, USA
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Jihong Wang
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Wen Li
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Josef Debbins
- Department of Radiology, Barrow Neurologic Institute, Phoenix, Arizona, USA
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eduardo Moros
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
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Maudsley AA, Andronesi OC, Barker PB, Bizzi A, Bogner W, Henning A, Nelson SJ, Posse S, Shungu DC, Soher BJ. Advanced magnetic resonance spectroscopic neuroimaging: Experts' consensus recommendations. NMR IN BIOMEDICINE 2021; 34:e4309. [PMID: 32350978 PMCID: PMC7606742 DOI: 10.1002/nbm.4309] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 02/01/2020] [Accepted: 03/10/2020] [Indexed: 05/04/2023]
Abstract
Magnetic resonance spectroscopic imaging (MRSI) offers considerable promise for monitoring metabolic alterations associated with disease or injury; however, to date, these methods have not had a significant impact on clinical care, and their use remains largely confined to the research community and a limited number of clinical sites. The MRSI methods currently implemented on clinical MRI instruments have remained essentially unchanged for two decades, with only incremental improvements in sequence implementation. During this time, a number of technological developments have taken place that have already greatly benefited the quality of MRSI measurements within the research community and which promise to bring advanced MRSI studies to the point where the technique becomes a true imaging modality, while making the traditional review of individual spectra a secondary requirement. Furthermore, the increasing use of biomedical MR spectroscopy studies has indicated clinical areas where advanced MRSI methods can provide valuable information for clinical care. In light of this rapidly changing technological environment and growing understanding of the value of MRSI studies for biomedical studies, this article presents a consensus from a group of experts in the field that reviews the state-of-the-art for clinical proton MRSI studies of the human brain, recommends minimal standards for further development of vendor-provided MRSI implementations, and identifies areas which need further technical development.
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Affiliation(s)
- Andrew A Maudsley
- Department of Radiology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ovidiu C Andronesi
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, Massachusetts
| | - Peter B Barker
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, and the Kennedy Krieger Institute, F.M. Kirby Center for Functional Brain Imaging, Baltimore, Maryland
| | - Alberto Bizzi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - Anke Henning
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah J Nelson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Stefan Posse
- Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Dikoma C Shungu
- Department of Neuroradiology, Weill Cornell Medical College, New York, New York
| | - Brian J Soher
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Castellano A, Bailo M, Cicone F, Carideo L, Quartuccio N, Mortini P, Falini A, Cascini GL, Minniti G. Advanced Imaging Techniques for Radiotherapy Planning of Gliomas. Cancers (Basel) 2021; 13:cancers13051063. [PMID: 33802292 PMCID: PMC7959155 DOI: 10.3390/cancers13051063] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-0-961-369-4155
| | - Luciano Carideo
- National Cancer Institute, G. Pascale Foundation, 80131 Naples, Italy;
| | - Natale Quartuccio
- A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90144 Palermo, Italy;
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Andrea Falini
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Giuseppe Lucio Cascini
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
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Derkaoui Hassani F, Melhaoui A, Dif Y, Oumoussa A, Jiddane M, Arkha Y, El Khamlichi A. Integration of Three-dimensional Magnetic Resonance Imaging Spectroscopy with the Leksell GammaPlan Radiosurgical Planning Station for the Treatment of Brain Tumors. Cureus 2019; 11:e5946. [PMID: 31777696 PMCID: PMC6867352 DOI: 10.7759/cureus.5946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction MRI multivoxel spectroscopy mapping is helpful in surgical decision-making. Unfortunately, in daily practice, MRI multivoxel spectroscopy mapping is not always compatible with the current version of Leksell GammaPlan (LGP) (Elekta, Stockholm, Sweden). The aim of this study is to develop a tool to allow the use of this modality in radiosurgical treatments using LGP. Material and methods Multivoxel spectroscopy digital imaging and communications in medicine (DICOM) images were analyzed to identify tags to be modified to make the images compatible with LGP. We identify four important tags to be modified for compatibility with LGP. Using Python language, a new software was designed to modify the identified tags and allow the automatic conversion of images to meet LGP requirements. Results By modifying the tags of DICOM images, we could use spectroscopic cartography images in radiosurgical planning using LGP. We created a software to reproduce these modifications using a simple and rapid interface. This software executes all the protocols established in the methodology. Conclusion The new software, “GP Adapting Solution”, can convert any DICOM image and make it compatible with LGP. The integration of multivoxel spectroscopic images was feasible and could be used for radiosurgical planning. This work is the first step in allowing the potential use of new MRI modalities in radiosurgical planning using LGP. The next steps are to evaluate the impact of these modalities in radiosurgical treatments and to develop methods for integrating other imaging modalities.
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Affiliation(s)
- Fahd Derkaoui Hassani
- Neurosurgery, Cheikh Zaid International Hospital, Center for Doctoral Studies in Life and Health Sciences (CEDoc-SVS), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Adyl Melhaoui
- Neuro Oncology - Functional Neurosurgery and Radiosurgery Research Team, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Younes Dif
- Neurosurgery, Center for Doctoral Studies in Life and Health Sciences (CEDoc-SVS), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Abdelhanine Oumoussa
- Neurosurgery, Center for Doctoral Studies in Life and Health Sciences (CEDoc-SVS), Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Mohammed Jiddane
- Neuroradiology, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Yasser Arkha
- Neurosurgery, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
| | - Abdeslam El Khamlichi
- Neuro Oncology - Functional Neurosurgery and Radiosurgery Research Team, Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, MAR
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Abstract
Magnetic resonance spectroscopy (MRS) can be performed in vivo using commercial MRI systems to obtain biochemical information about tissues and cancers. Applications in brain, prostate and breast aid lesion detection and characterisation (differential diagnosis), treatment planning and response assessment. Multi-centre clinical trials have been performed in all these tissues. Single centre studies have been performed in many other tissues including cervix, uterus, musculoskeletal and liver. While generally MRS is used to study endogenous metabolites it has also been used in drug studies, for example those that include 19F as part of their structure. Recently the hyperpolarisation of compounds enriched with 13C such as [1-13C] pyruvate has been demonstrated in animal models and now in preliminary clinical studies, permitting the monitoring of biochemical processes with unprecedented sensitivity. This review briefly introduces the underlying methods and then discusses the current status of these applications.
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Affiliation(s)
- Geoffrey S Payne
- University Hospitals Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, United Kingdom
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Séhédic D, Chourpa I, Tétaud C, Griveau A, Loussouarn C, Avril S, Legendre C, Lepareur N, Wion D, Hindré F, Davodeau F, Garcion E. Locoregional Confinement and Major Clinical Benefit of 188Re-Loaded CXCR4-Targeted Nanocarriers in an Orthotopic Human to Mouse Model of Glioblastoma. Am J Cancer Res 2017; 7:4517-4536. [PMID: 29158842 PMCID: PMC5695146 DOI: 10.7150/thno.19403] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 09/11/2017] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Gold standard beam radiation for glioblastoma (GBM) treatment is challenged by resistance phenomena occurring in cellular populations well prepared to survive or to repair damage caused by radiation. Among signals that have been linked with radio-resistance, the SDF1/CXCR4 axis, associated with cancer stem-like cell, may be an opportune target. To avoid the problem of systemic toxicity and blood-brain barrier crossing, the relevance and efficacy of an original system of local brain internal radiation therapy combining a radiopharmaceutical with an immuno-nanoparticle was investigated. EXPERIMENT DESIGN The nanocarrier combined lipophilic thiobenzoate complexes of rhenium-188 loaded in the core of a lipid nanocapsule (LNC188Re) with a function-blocking antibody, 12G5 directed at the CXCR4, on its surface. The efficiency of 12G5-LNC188Re was investigated in an orthotopic and xenogenic GBM model of CXCR4-positive U87MG cells implanted in the striatum of Scid mice. RESULTS We demonstrated that 12G5-LNC188Re single infusion treatment by convection-enhanced delivery resulted in a major clinical improvement in median survival that was accompanied by locoregional effects on tumor development including hypovascularization and stimulation of the recruitment of bone marrow derived CD11b- or CD68-positive cells as confirmed by immunohistochemistry analysis. Interestingly, thorough analysis by spectral imaging in a chimeric U87MG GBM model containing CXCR4-positive/red fluorescent protein (RFP)-positive- and CXCR4-negative/RFP-negative-GBM cells revealed greater confinement of DiD-labeled 12G5-LNCs than control IgG2a-LNCs in RFP compartments. Main conclusion: These findings on locoregional impact and targeting of disseminated cancer cells in tumor margins suggest that intracerebral active targeting of nanocarriers loaded with radiopharmaceuticals may have considerable benefits in clinical applications.
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Salzillo TC, Hu J, Nguyen L, Whiting N, Lee J, Weygand J, Dutta P, Pudakalakatti S, Millward NZ, Gammon ST, Lang FF, Heimberger AB, Bhattacharya PK. Interrogating Metabolism in Brain Cancer. Magn Reson Imaging Clin N Am 2017; 24:687-703. [PMID: 27742110 DOI: 10.1016/j.mric.2016.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article reviews existing and emerging techniques of interrogating metabolism in brain cancer from well-established proton magnetic resonance spectroscopy to the promising hyperpolarized metabolic imaging and chemical exchange saturation transfer and emerging techniques of imaging inflammation. Some of these techniques are at an early stage of development and clinical trials are in progress in patients to establish the clinical efficacy. It is likely that in vivo metabolomics and metabolic imaging is the next frontier in brain cancer diagnosis and assessing therapeutic efficacy; with the combined knowledge of genomics and proteomics a complete understanding of tumorigenesis in brain might be achieved.
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Affiliation(s)
- Travis C Salzillo
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jingzhe Hu
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; Department of Bioengineering, Rice University, Houston, TX, USA
| | - Linda Nguyen
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nicholas Whiting
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Jaehyuk Lee
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Joseph Weygand
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Prasanta Dutta
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Shivanand Pudakalakatti
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Niki Zacharias Millward
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Seth T Gammon
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Amy B Heimberger
- Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA
| | - Pratip K Bhattacharya
- Department of Cancer Systems Imaging, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Brandão LA, Castillo M. Adult Brain Tumors: Clinical Applications of Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2017; 24:781-809. [PMID: 27742117 DOI: 10.1016/j.mric.2016.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Proton magnetic resonance spectroscopy (H-MRS) may be helpful in suggesting tumor histology and tumor grade and may better define tumor extension and the ideal site for biopsy compared with conventional magnetic resonance (MR) imaging. A multifunctional approach with diffusion-weighted imaging, perfusion-weighted imaging, and permeability maps, along with H-MRS, may enhance the accuracy of the diagnosis and characterization of brain tumors and estimation of therapeutic response. Integration of advanced imaging techniques with conventional MR imaging and the clinical history help to improve the accuracy, sensitivity, and specificity in differentiating tumors and nonneoplastic lesions.
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Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Av. Das Américas 700, sala 320, Barra da Tijuca, Rio de Janeiro 30112011, Brazil; Clínica IRM- Ressonância Magnética, Rua Capitão Salomão 44 Humaitá, Rio de Janeiro 22271040, Brazil.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
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10
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Abstract
Imaging is integral to the management of patients with brain tumors. Conventional structural imaging provides exquisite anatomic detail but remains limited in the evaluation of molecular characteristics of intracranial neoplasms. Quantitative and physiologic biomarkers derived from advanced imaging techniques have been increasingly utilized as problem-solving tools to identify glioma grade and assess response to therapy. This chapter provides a comprehensive overview of the imaging strategies used in the clinical assessment of patients with gliomas and describes how novel imaging biomarkers have the potential to improve patient management.
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Affiliation(s)
- Whitney B Pope
- Radiological Sciences, Ronald Reagan Medical Center, Los Angeles, CA, USA.
| | - Ibrahim Djoukhadar
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Alan Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
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11
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Laprie A, Hu Y, Alapetite C, Carrie C, Habrand JL, Bolle S, Bondiau PY, Ducassou A, Huchet A, Bertozzi AI, Perel Y, Moyal É, Balosso J. Paediatric brain tumours: A review of radiotherapy, state of the art and challenges for the future regarding protontherapy and carbontherapy. Cancer Radiother 2015; 19:775-89. [PMID: 26548600 DOI: 10.1016/j.canrad.2015.05.028] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 05/18/2015] [Accepted: 05/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Brain tumours are the most frequent solid tumours in children and the most frequent radiotherapy indications in paediatrics, with frequent late effects: cognitive, osseous, visual, auditory and hormonal. A better protection of healthy tissues by improved beam ballistics, with particle therapy, is expected to decrease significantly late effects without decreasing local control and survival. This article reviews the scientific literature to advocate indications of protontherapy and carbon ion therapy for childhood central nervous system cancer, and estimate the expected therapeutic benefits. MATERIALS AND METHODS A systematic review was performed on paediatric brain tumour treatments using Medline (from 1966 to March of 2014). To be included, clinical trials had to meet the following criteria: age of patients 18 years or younger, treated with radiation, and report of survival. Studies were also selected according to the evidence level. A secondary search of cited references found other studies about cognitive functions, quality of life, the comparison of photon and proton dosimetry showing potential dose escalation and/or sparing of organs at risk with protontherapy; and studies on dosimetric and technical issues related to protontherapy. RESULTS A total of 7051 primary references published were retrieved, among which 40 clinical studies and 60 papers about quality of life, dose distribution and dosimetry were analysed, as well as the ongoing clinical trials. These papers have been summarized and reported in a specific document made available to the participants of a final 1-day workshop. Tumours of the meningeal envelop and bony cranial structures were excluded from the analysis. Protontherapy allows outstanding ballistics to target the tumour area, while substantially decreasing radiation dose to the normal tissues. There are many indications of protontherapy for paediatric brain tumours in curative intent, either for localized treatment of ependymomas, germ-cell tumours, craniopharyngiomas, low-grade gliomas; or panventricular irradiation of pure non-secreting germinoma; or craniospinal irradiation of medulloblastomas and metastatic pure germinomas. Carbon ion therapy is just emerging and may be studied for highly aggressive and radioresistant tumours, as an initial treatment for diffuse brainstem gliomas, and for relapse of high-grade gliomas. CONCLUSION Both protontherapy and carbon ion therapy are promising for paediatric brain tumours. The benefit of decreasing late effects without altering survival has been described for most paediatric brain tumours with protontherapy and is currently assessed in ongoing clinical trials with up-to-date proton devices. Unfortunately, in 2015, only a minority of paediatric patients in France can receive protontherapy due to the lack of equipment.
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Affiliation(s)
- A Laprie
- Université Paul-Sabatier, Toulouse, France; Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France.
| | - Y Hu
- GCS-Étoile-France-Hadron, Lyon, France
| | - C Alapetite
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France
| | - C Carrie
- GCS-Étoile-France-Hadron, Lyon, France; Centre Léon-Bérard, Lyon, France
| | - J-L Habrand
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France; Université Paris Sud, Orsay, France; Archade-France-Hadron, Caen, France; Centre François-Baclesse, Caen, France; Gustave-Roussy, Villejuif, France
| | - S Bolle
- Institut Curie Paris Orsay (ICPO)-France-Hadron, Orsay, France; Impact-France-Hadron, Nice, France
| | - P-Y Bondiau
- Centre Antoine-Lacassagne, Nice, France; CHU de Bordeaux, Bordeaux, France
| | - A Ducassou
- Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France
| | - A Huchet
- Hôpital des Enfants, Toulouse, France
| | - A-I Bertozzi
- Périclès-France-Hadron, Toulouse, France; Université Grenoble Alpes, Grenoble, France
| | - Y Perel
- Université Grenoble Alpes, Grenoble, France
| | - É Moyal
- Université Paul-Sabatier, Toulouse, France; Institut Claudius-Regaud, institut universitaire du cancer de Toulouse (IUCT)-Oncopole, radiation oncology, 1, avenue Irene-Joliot-Curie, 31059 Toulouse, France; Périclès-France-Hadron, Toulouse, France
| | - J Balosso
- GCS-Étoile-France-Hadron, Lyon, France; CHU de Grenoble, Grenoble, France
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Chaumeil MM, Lupo JM, Ronen SM. Magnetic Resonance (MR) Metabolic Imaging in Glioma. Brain Pathol 2015; 25:769-80. [PMID: 26526945 PMCID: PMC8029127 DOI: 10.1111/bpa.12310] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 12/25/2022] Open
Abstract
This review is focused on describing the use of magnetic resonance (MR) spectroscopy for metabolic imaging of brain tumors. We will first review the MR metabolic imaging findings generated from preclinical models, focusing primarily on in vivo studies, and will then describe the use of metabolic imaging in the clinical setting. We will address relatively well-established (1) H MRS approaches, as well as (31) P MRS, (13) C MRS and emerging hyperpolarized (13) C MRS methodologies, and will describe the use of metabolic imaging for understanding the basic biology of glioma as well as for improving the characterization and monitoring of brain tumors in the clinic.
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Affiliation(s)
| | - Janine M. Lupo
- Department of Radiology and Biomedical ImagingMission Bay Campus
| | - Sabrina M. Ronen
- Department of Radiology and Biomedical ImagingMission Bay Campus
- Brain Tumor Research CenterUniversity of CaliforniaSan FranciscoCA
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13
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Advanced magnetic resonance imaging methods for planning and monitoring radiation therapy in patients with high-grade glioma. Semin Radiat Oncol 2014; 24:248-58. [PMID: 25219809 DOI: 10.1016/j.semradonc.2014.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This review explores how the integration of advanced imaging methods with high-quality anatomical images significantly improves the characterization, target definition, assessment of response to therapy, and overall management of patients with high-grade glioma. Metrics derived from diffusion-, perfusion-, and susceptibility-weighted magnetic resonance imaging in conjunction with magnetic resonance spectroscopic imaging, allows us to characterize regions of edema, hypoxia, increased cellularity, and necrosis within heterogeneous tumor and surrounding brain tissue. Quantification of such measures may provide a more reliable initial representation of tumor delineation and response to therapy than changes in the contrast-enhancing or T2 lesion alone and have a significant effect on targeting resection, planning radiation, and assessing treatment effectiveness. In the long term, implementation of these imaging methodologies can also aid in the identification of recurrent tumor and its differentiation from treatment-related confounds and facilitate the detection of radiationinduced vascular injury in otherwise normal-appearing brain tissue.
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14
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Parra NA, Maudsley AA, Gupta RK, Ishkanian F, Huang K, Walker GR, Padgett K, Roy B, Panoff J, Markoe A, Stoyanova R. Volumetric spectroscopic imaging of glioblastoma multiforme radiation treatment volumes. Int J Radiat Oncol Biol Phys 2014; 90:376-84. [PMID: 25066215 DOI: 10.1016/j.ijrobp.2014.03.049] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/27/2014] [Accepted: 03/28/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE Magnetic resonance (MR) imaging and computed tomography (CT) are used almost exclusively in radiation therapy planning of glioblastoma multiforme (GBM), despite their well-recognized limitations. MR spectroscopic imaging (MRSI) can identify biochemical patterns associated with normal brain and tumor, predominantly by observation of choline (Cho) and N-acetylaspartate (NAA) distributions. In this study, volumetric 3-dimensional MRSI was used to map these compounds over a wide region of the brain and to evaluate metabolite-defined treatment targets (metabolic tumor volumes [MTV]). METHODS AND MATERIALS Volumetric MRSI with effective voxel size of ∼1.0 mL and standard clinical MR images were obtained from 19 GBM patients. Gross tumor volumes and edema were manually outlined, and clinical target volumes (CTVs) receiving 46 and 60 Gy were defined (CTV46 and CTV60, respectively). MTVCho and MTVNAA were constructed based on volumes with high Cho and low NAA relative to values estimated from normal-appearing tissue. RESULTS The MRSI coverage of the brain was between 70% and 76%. The MTVNAA were almost entirely contained within the edema, and the correlation between the 2 volumes was significant (r=0.68, P=.001). In contrast, a considerable fraction of MTVCho was outside of the edema (median, 33%) and for some patients it was also outside of the CTV46 and CTV60. These untreated volumes were greater than 10% for 7 patients (37%) in the study, and on average more than one-third (34.3%) of the MTVCho for these patients were outside of CTV60. CONCLUSIONS This study demonstrates the potential usefulness of whole-brain MRSI for radiation therapy planning of GBM and revealed that areas of metabolically active tumor are not covered by standard RT volumes. The described integration of MTV into the RT system will pave the way to future clinical trials investigating outcomes in patients treated based on metabolic information.
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Affiliation(s)
- N Andres Parra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew A Maudsley
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Rakesh K Gupta
- Department of Radiology & Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Fazilat Ishkanian
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Kris Huang
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Gail R Walker
- Biostatistics and Bioinformatics Core Resource, Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Kyle Padgett
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida; Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Bhaswati Roy
- Department of Radiology & Imaging, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Joseph Panoff
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Arnold Markoe
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida.
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15
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Chronaiou I, Stensjøen AL, Sjøbakk TE, Esmaeili M, Bathen TF. Impacts of MR spectroscopic imaging on glioma patient management. Acta Oncol 2014; 53:580-9. [PMID: 24628262 DOI: 10.3109/0284186x.2014.891046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Magnetic resonance (MR) modalities are routine imaging tools in the diagnosis and management of gliomas. MR spectroscopic imaging (MRSI), which relies on the metabolic characteristics of tissues, has been developed to accelerate the understanding of gliomas and to aid in effective clinical decision making and development of targeted therapies. In this review, the potentials and practical challenges to frequently use this technique in clinical management of gliomas are discussed. The applications of new biomarkers detectable by MRSI in differential glioma diagnosis, pre- and post-treatment evaluations, and neurosurgery are also addressed.
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Affiliation(s)
- Ioanna Chronaiou
- Radiography Department, Faculty of Technology (AFT), Sør-Trøndelag University College (HiST) , Trondheim , Norway
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16
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Kasten J, Lazeyras F, Van De Ville D. Data-driven MRSI spectral localization via low-rank component analysis. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:1853-1863. [PMID: 23744674 DOI: 10.1109/tmi.2013.2266259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Magnetic resonance spectroscopic imaging (MRSI) is a powerful tool capable of providing spatially localized maps of metabolite concentrations. Its utility, however, is often depreciated by spectral leakage artifacts resulting from low spatial resolution measurements through an effort to reduce acquisition times. Though model-based techniques can help circumvent these drawbacks, they require strong prior knowledge, and can introduce additional artifacts when the underlying models are inaccurate. We introduce a novel scheme in which a generative model is estimated from the raw MRSI data via a regularized variational framework that minimizes the model approximation error within a measurement-prescribed subspace. As additional a priori information, our approach relies only upon a measured field inhomogeneity map at high spatial resolution. We demonstrate the feasibility of our approach on both synthetic and experimental data.
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17
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18
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Quantification in magnetic resonance spectroscopy based on semi-parametric approaches. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2013; 27:113-30. [DOI: 10.1007/s10334-013-0393-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 07/08/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
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19
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Kwee TC, Donswijk ML. Application of Advanced MR Imaging Techniques and the Evolving Role of PET/MR Imaging in Neuro-oncology. PET Clin 2013; 8:183-99. [DOI: 10.1016/j.cpet.2012.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Importance of neuroimaging accuracy in radiosurgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013. [PMID: 23417474 DOI: 10.1007/978-3-7091-1376-9_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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21
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Kircher MF, Hricak H, Larson SM. Molecular imaging for personalized cancer care. Mol Oncol 2012; 6:182-95. [PMID: 22469618 PMCID: PMC5528375 DOI: 10.1016/j.molonc.2012.02.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 02/20/2012] [Accepted: 02/20/2012] [Indexed: 12/19/2022] Open
Abstract
Molecular imaging is rapidly gaining recognition as a tool with the capacity to improve every facet of cancer care. Molecular imaging in oncology can be defined as in vivo characterization and measurement of the key biomolecules and molecularly based events that are fundamental to the malignant state. This article outlines the basic principles of molecular imaging as applied in oncology with both established and emerging techniques. It provides examples of the advantages that current molecular imaging techniques offer for improving clinical cancer care as well as drug development. It also discusses the importance of molecular imaging for the emerging field of theranostics and offers a vision of how molecular imaging may one day be integrated with other diagnostic techniques to dramatically increase the efficiency and effectiveness of cancer care.
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Affiliation(s)
- Moritz F. Kircher
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-278, NY 10065, USA
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22
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Spatial characteristics of newly diagnosed grade 3 glioma assessed by magnetic resonance metabolic and diffusion tensor imaging. Transl Oncol 2012; 5:10-8. [PMID: 22348171 DOI: 10.1593/tlo.11208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 10/25/2011] [Accepted: 10/31/2011] [Indexed: 11/18/2022] Open
Abstract
The spatial heterogeneity in magnetic resonance (MR) metabolic and diffusion parameters and their relationship were studied for patients with treatment-naive grade 3 gliomas. MR data were evaluated from 51 patients with newly diagnosed grade 3 gliomas. Anatomic, diffusion, and metabolic imaging data were considered. Variations in metabolite levels, apparent diffusion coefficient (ADC), and fractional anisotropy (FA) were evaluated in regions of gadolinium enhancement and T2 hyperintensity as well as regions with abnormal metabolic signatures. Contrast enhancement was present in only 21 of the 51 patients. When present, the enhancing component of the lesion had higher choline-to-N-acetylaspartate index (CNI), higher choline, lower N-acetylaspartate, similar creatine, similar ADC and FA, and higher lactate/lipid than the nonenhancing lesion. Regions with CNI ≥ 4 had higher choline, lower N-acetylaspartate, higher lactate/lipid, higher ADC, and lower FA than normal-appearing white matter and regions with intermediate CNI values. For lesions that exhibited gadolinium enhancement, the metabolite levels and diffusion parameters in the region of enhancement were consistent with it corresponding to the most abnormal portion of the tumor. For nonenhancing lesions, areas with CNI ≥ 4 were the most abnormal in metabolic and diffusion parameters. This suggests that the region with the highest CNI might provide a good target for biopsies for nonenhancing lesions to obtain a representative histologic diagnosis of its degree of malignancy. Metabolic and diffusion parameter levels may be of interest not only for directing tissue sampling but also for defining the targets for focal therapy and assessing response to therapy.
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23
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High Field MR Spectroscopy: Investigating Human Metabolite Levels at High Spectral and Spatial Resolution. HIGH-FIELD MR IMAGING 2012. [DOI: 10.1007/174_2011_201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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24
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Elliott RE, Parker EC, Rush SC, Kalhorn SP, Moshel YA, Narayana A, Donahue B, Golfinos JG. Efficacy of gamma knife radiosurgery for small-volume recurrent malignant gliomas after initial radical resection. World Neurosurg 2011; 76:128-40; discussion 61-2. [PMID: 21839964 DOI: 10.1016/j.wneu.2010.12.053] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 12/20/2010] [Accepted: 12/20/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To review the authors' experience with Gamma Knife radiosurgery (GKR) for small recurrent high-grade gliomas (HGGs) following prior radical resection, external-beam radiation therapy (EBRT), and chemotherapy with temozolomide (TMZ). METHODS The authors retrospectively analyzed 26 consecutive adults (9 women and 17 men; median age 60.4 years; Karnofsky Performance Status [KPS]≥70) who underwent GKR for recurrent HGGs from 2004-2009. Median lesion volume was 1.22 cc, and median treatment dose was 15 Gy. Pathology included glioblastoma multiforme (GBM; n=16), anaplastic astrocytoma (AA; n=5), and anaplastic mixed oligoastrocytoma (AMOA; n=5). Two patients lost to follow-up were excluded from radiographic outcome analyses. RESULTS Median overall survival (OS) for the entire cohort from the time of GKR was 13.5 months. Values for 12-month actuarial survival from time of GKR for GBM, AMOA, and AA were 37%, 20% and 80%. Local failure occurred in 9 patients (37.5%) at a median time of 5.8 months, and 18 patients (75%) experienced distant progression at a median of 4.8 months. Complications included radiation necrosis in two patients and transient worsening of hemiparesis in one patient. Multivariate hazard ratio (HR) analysis showed KPS 90 or greater, smaller tumor volumes, and increased time to recurrence after resection to be associated with longer OS following GKR. CONCLUSIONS GKR provided good local tumor control in this group of clinically stable and predominantly high-functioning patients with small recurrent HGGs after radical resection. Meaningful survival times after GKR were seen. GKR can be considered for selected patients with recurrent HGGs.
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Affiliation(s)
- Robert E Elliott
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York, USA
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25
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Nelson SJ. Assessment of therapeutic response and treatment planning for brain tumors using metabolic and physiological MRI. NMR IN BIOMEDICINE 2011; 24:734-49. [PMID: 21538632 PMCID: PMC3772179 DOI: 10.1002/nbm.1669] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/14/2010] [Accepted: 12/10/2010] [Indexed: 05/26/2023]
Abstract
MRI is routinely used for diagnosis, treatment planning and assessment of response to therapy for patients with glioma. Gliomas are spatially heterogeneous and infiltrative lesions that are quite variable in terms of their response to therapy. Patients classified as having low-grade histology have a median overall survival of 7 years or more, but need to be monitored carefully to make sure that their tumor does not upgrade to a more malignant phenotype. Patients with the most aggressive grade IV histology have a median overall survival of 12-15 months and often undergo multiple surgeries and adjuvant therapies in an attempt to control their disease. Despite improvements in the spatial resolution and sensitivity of anatomic images, there remain considerable ambiguities in the interpretation of changes in the size of the gadolinium-enhancing lesion on T(1) -weighted images as a measure of treatment response, and in differentiating between treatment effects and infiltrating tumor within the larger T(2) lesion. The planning of focal therapies, such as surgery, radiation and targeted drug delivery, as well as a more reliable assessment of the response to therapy, would benefit considerably from the integration of metabolic and physiological imaging techniques into routine clinical MR examinations. Advanced methods that have been shown to provide valuable data for patients with glioma are diffusion, perfusion and spectroscopic imaging. Multiparametric examinations that include the acquisition of such data are able to assess tumor cellularity, hypoxia, disruption of normal tissue architecture, changes in vascular density and vessel permeability, in addition to the standard measures of changes in the volume of enhancing and nonenhancing anatomic lesions. This is particularly critical for the interpretation of the results of Phase I and Phase II clinical trials of novel therapies, which are increasingly including agents that are designed to have anti-angiogenic and anti-proliferative properties as opposed to having a direct effect on tumor cell viability.
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Affiliation(s)
- Sarah J Nelson
- University of California at San Francisco - Mission Bay, San Francisco, CA, USA.
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26
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Yamasaki F, Kurisu K, Kajiwara Y, Watanabe Y, Takayasu T, Akiyama Y, Saito T, Hanaya R, Sugiyama K. Magnetic resonance spectroscopic detection of lactate is predictive of a poor prognosis in patients with diffuse intrinsic pontine glioma. Neuro Oncol 2011; 13:791-801. [PMID: 21653595 DOI: 10.1093/neuonc/nor038] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Diffuse brainstem glioma has a poor prognosis, and there are few long-term survivors. We looked for clinical, conventional magnetic resonance (MR), and MR spectroscopic (MRS) findings predictive of the prognosis of patients with brainstem glioma. Our institutional review board approved this retrospective study of 23 patients with diffuse intrinsic pontine or diffuse medullary brainstem glioma treated during the period 2000-2009. To evaluate prognostic values, we performed a Kaplan-Meier survival analysis (log-rank test) that incorporated the patients' age and sex, symptom duration, the presence or absence of cranial nerve palsy, long tract sign, ataxia, and cysts, the chemotherapeutic regimen, Gd enhancement, longitudinal and cerebellar extension, basilar artery encasement, and MRS parameters. Of the 23 diffuse brainstem gliomas, 19 were located at the pons (ratio of male to female patients, 1.1:1). The mean age of the 23 patients was 15.9 years (range, 4-50 years); 16 were aged <20 years. The duration of overall survival was 19.7 months; in patients with diffuse intrinsic pontine glioma, it was 16.6 months, and in patients aged <20 years, it was 11.8 months. Clinical and conventional MR findings at presentation were not predictive of the prognosis in children with diffuse intrinsic pontine glioma. In addition, a patient age <20 years and the detection of lactate by MRS were poor prognostic factors. The MRS detection of lactate is a prognostic factor in patients with diffuse intrinsic pontine glioma. Additional studies of larger patient populations using other imaging modalities are needed.
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Affiliation(s)
- Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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27
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Fogh S, Andrews D, Clarke J, Werner-Wasik M. Reply to C. Nieder. J Clin Oncol 2011. [DOI: 10.1200/jco.2010.31.6901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shannon Fogh
- University of California, San Francisco, CA; Thomas Jefferson University, Philadelphia, PA
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28
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Horská A, Barker PB. Imaging of brain tumors: MR spectroscopy and metabolic imaging. Neuroimaging Clin N Am 2010; 20:293-310. [PMID: 20708548 DOI: 10.1016/j.nic.2010.04.003] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The utility of magnetic resonance spectroscopy (MRS) in diagnosis and evaluation of treatment response to human brain tumors has been widely documented. The role of MRS in tumor classification, tumors versus nonneoplastic lesions, prediction of survival, treatment planning, monitoring of therapy, and post-therapy evaluation is discussed. This article delineates the need for standardization and further study in order for MRS to become widely used as a routine clinical tool.
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Affiliation(s)
- Alena Horská
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Abstract
"Dose-painting" radiotherapy allows for a heterogeneous delivery of radiation within the tumour volume by targeting radioresistant areas defined by functional imaging. Within gross tumour volume, it is possible to define one or more target volumes based on biology (biological target volume [BTV]) and to apply a strategy of intensity modulated radiation therapy (IMRT) that will deliver a higher dose to these regions. In this review of the literature, we will highlight the biological elements responsible for radioresistance, and how to image them, then we will detail the radiotherapy techniques necessary for this approach, before presenting clinical results in various situations (head and neck tumours, prostate, brain tumours, etc.). Despite many difficulties that make dose-painting IMRT unusable in routine nowadays, biology-guided radiation therapy represents one of the major pathways of development of radiotherapy in the coming years.
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Tsien C, Galbán CJ, Chenevert TL, Johnson TD, Hamstra DA, Sundgren PC, Junck L, Meyer CR, Rehemtulla A, Lawrence T, Ross BD. Parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma. J Clin Oncol 2010; 28:2293-9. [PMID: 20368564 DOI: 10.1200/jco.2009.25.3971] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess whether a new method of quantifying therapy-associated hemodynamic alterations may help to distinguish pseudoprogression from true progression in patients with high-grade glioma. PATIENTS AND METHODS Patients with high-grade glioma received concurrent chemoradiotherapy. Relative cerebral blood volume (rCBV) and blood flow (rCBF) maps were acquired before chemoradiotherapy and at week 3 during treatment on a prospective institutional review board-approved study. Pseudoprogression was defined as imaging changes 1 to 3 months after chemoradiotherapy that mimic tumor progression but stabilized or improved without change in treatment or for which resection revealed radiation effects only. Clinical and conventional magnetic resonance (MR) parameters, including average percent change of rCBV and CBF, were evaluated as potential predictors of pseudoprogression. Parametric response map (PRM), an innovative, voxel-by-voxel method of image analysis, was also performed. RESULTS Median radiation dose was 72 Gy (range, 60 to 78 Gy). Of 27 patients, stable disease/partial response was noted in 13 patients and apparent progression was noted in 14 patients. Adjuvant temozolomide was continued in all patients. Pseudoprogression occurred in six patients. Based on PRM analysis, a significantly reduced blood volume (PRM(rCBV)) at week 3 was noted in patients with progressive disease as compared with those with pseudoprogression (P < .01). In contrast, change in average percent rCBV or rCBF, MR tumor volume changes, age, extent of resection, and Radiation Therapy Oncology Group recursive partitioning analysis classification did not distinguish progression from pseudoprogression. CONCLUSION PRM(rCBV) at week 3 during chemoradiotherapy is a potential early imaging biomarker of response that may be helpful in distinguishing pseudoprogression from true progression in patients with high-grade glioma.
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Affiliation(s)
- Christina Tsien
- Department of Radiation Oncology, University of Michigan Medical Center, 1500 E. Medical Center Dr, Ann Arbor, MI 48109, USA.
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Ozturk-Isik E, Chen AP, Crane JC, Bian W, Xu D, Han ET, Chang SM, Vigneron DB, Nelson SJ. 3D sensitivity encoded ellipsoidal MR spectroscopic imaging of gliomas at 3T. Magn Reson Imaging 2009; 27:1249-57. [PMID: 19766422 DOI: 10.1016/j.mri.2009.05.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 04/04/2009] [Accepted: 05/07/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE The goal of this study was to implement time efficient data acquisition and reconstruction methods for 3D magnetic resonance spectroscopic imaging (MRSI) of gliomas at a field strength of 3T using parallel imaging techniques. METHODS The point spread functions, signal to noise ratio (SNR), spatial resolution, metabolite intensity distributions and Cho:NAA ratio of 3D ellipsoidal, 3D sensitivity encoding (SENSE) and 3D combined ellipsoidal and SENSE (e-SENSE) k-space sampling schemes were compared with conventional k-space data acquisition methods. RESULTS The 3D SENSE and e-SENSE methods resulted in similar spectral patterns as the conventional MRSI methods. The Cho:NAA ratios were highly correlated (P<.05 for SENSE and P<.001 for e-SENSE) with the ellipsoidal method and all methods exhibited significantly different spectral patterns in tumor regions compared to normal appearing white matter. The geometry factors ranged between 1.2 and 1.3 for both the SENSE and e-SENSE spectra. When corrected for these factors and for differences in data acquisition times, the empirical SNRs were similar to values expected based upon theoretical grounds. The effective spatial resolution of the SENSE spectra was estimated to be same as the corresponding fully sampled k-space data, while the spectra acquired with ellipsoidal and e-SENSE k-space samplings were estimated to have a 2.36-2.47-fold loss in spatial resolution due to the differences in their point spread functions. CONCLUSION The 3D SENSE method retained the same spatial resolution as full k-space sampling but with a 4-fold reduction in scan time and an acquisition time of 9.28 min. The 3D e-SENSE method had a similar spatial resolution as the corresponding ellipsoidal sampling with a scan time of 4:36 min. Both parallel imaging methods provided clinically interpretable spectra with volumetric coverage and adequate SNR for evaluating Cho, Cr and NAA.
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Affiliation(s)
- Esin Ozturk-Isik
- Margaret Hart Surbeck Laboratory of Advanced Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94158, USA.
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Tsien CI, Cao Y, Lawrence TS. Functional and metabolic magnetic resonance imaging and positron emission tomography for tumor volume definition in high-grade gliomas. Semin Radiat Oncol 2009; 19:155-62. [PMID: 19464630 DOI: 10.1016/j.semradonc.2009.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although the addition of concurrent and adjuvant temozolomide (TMZ) to standard-dose radiation (60 Gy) improves survival, the pattern of failure continues to be local. Conventional contrast enhanced T1-weighted and T2-weighted magnetic resonance imaging (MRI) used for radiation planning reflect anatomic rather than molecular or functional, properties of the tumor. Functional and metabolic MRI and positron emission tomography are able to detect metabolic and functional abnormalities beyond the tumor volume seen on conventional MRI, assess early response to treatment, and delineate the regions of high risks for failure in high-grade gliomas. This article focuses on the potential of these functional and metabolic imaging techniques to refine our clinical target volumes.
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Affiliation(s)
- Christina I Tsien
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA.
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Survival following stereotactic radiosurgery for newly diagnosed and recurrent glioblastoma multiforme: a multicenter experience. Neurosurg Rev 2009; 32:417-24. [PMID: 19633875 DOI: 10.1007/s10143-009-0212-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 02/23/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
Abstract
Despite decades of clinical trials investigating new treatment modalities for glioblastoma multiforme (GBM), there have been no significant treatment advances since the 1980s. Reported median survival times for patients with GBM treated with current modalities generally range from 9 to 19 months. The purpose of the current study is to retrospectively review the ability of CyberKnife (Accuray Incorporated, Sunnyvale, CA, USA) radiosurgery to provide local tumor control of newly diagnosed or recurrent GBM. Twenty patients (43.5%) underwent CyberKnife treatment at the time of the initial diagnosis and/or during the first 3 months of their initial clinical management. Twenty-six patients (56.5%) were treated at the time of tumor recurrence or progression. CyberKnife was performed in addition to the traditional therapy. The median survival from diagnosis for the patients treated with CyberKnife as an initial clinical therapy was 11.5 months (range, 2-33) compared to 21 months (range, 8-96) for the patients treated at the time of tumor recurrence/progression. This difference was statistically significant (Kaplan-Meier analysis, P = 0.0004). The median survival from the CyberKnife treatment was 9.5 months (range, 0.25-31 months) and 7 months (range, 1-34 months) for patients in the newly diagnosed and recurrent GBM groups (Kaplan-Meier analysis, P = 0.79), respectively. Cox proportional hazards survival regression analysis demonstrated that survival time did not correlate significantly with treatment parameters (Dmax, Dmin, number of fractions) or target volume. Survival time and recursive partitioning analysis class were not correlated (P = 0.07). Patients with more extensive surgical interventions survived longer (P = 0.008), especially those who underwent total tumor resection vs. biopsy (P = 0.004). There is no apparent survival advantage in using CyberKnife in initial management of glioblastoma patients, and it should be reserved for patients whose tumors recur or progress after conventional therapy.
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Waldman AD, Jackson A, Price SJ, Clark CA, Booth TC, Auer DP, Tofts PS, Collins DJ, Leach MO, Rees JH. Quantitative imaging biomarkers in neuro-oncology. Nat Rev Clin Oncol 2009; 6:445-54. [PMID: 19546864 DOI: 10.1038/nrclinonc.2009.92] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Conventional structural imaging provides limited information on tumor characterization and prognosis. Advances in neurosurgical techniques, radiotherapy planning and novel drug treatments for brain tumors have generated increasing need for reproducible, noninvasive, quantitative imaging biomarkers. This Review considers the role of physiological MRI and PET molecular imaging in understanding metabolic processes associated with tumor growth, blood flow and ultrastructure. We address the utility of various techniques in distinguishing between tumors and non-neoplastic processes, in tumor grading, in defining anatomical relationships between tumor and eloquent brain regions and in determining the biological substrates of treatment response. Much of the evidence is derived from limited case series in individual centers. Despite their 'added value', the effect of these techniques as an adjunct to structural imaging in clinical research and practice remains limited.
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Jissendi Tchofo P, Balériaux D. Brain 1H-MR spectroscopy in clinical neuroimaging at 3T. J Neuroradiol 2009; 36:24-40. [DOI: 10.1016/j.neurad.2008.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lipani JD, Jackson PS, Soltys SG, Sato K, Adler JR. Survival following CyberKnife radiosurgery and hypofractionated radiotherapy for newly diagnosed glioblastoma multiforme. Technol Cancer Res Treat 2008; 7:249-55. [PMID: 18473497 DOI: 10.1177/153303460800700311] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Current therapeutic goals for treatment of Glioblastoma Multiforme (GBM) involve gross total resection followed by multifractionated focal external beam radiation therapy (EBRT). Patients treated with optimal therapy have a median survival of approximately 12-15 months. In the present study, we sought to determine whether a hypofractionated dosing schedule using CyberKnife is at least as effective as multifractionated focal EBRT. A retrospective analysis was conducted on 20 histopathologically confirmed GBM patients treated with CyberKnife at Okayama Kyokuto Hospital in Japan after gross total resection (n=11), subtotal resection (n=8), or biopsy (n=1). Eight patients also received adjuvant ACNU and Vincrisitine chemotherapy according to local protocol; however, no patient received any other form of radiation besides post surgical/biopsy CyberKnife treatment. The treated tumor volumes ranged from 9.62 cm(3)-185.81 cm(3) (mean: 86.08 cm(3)). The marginal dose (D90) ranged from 19.99 Gy-41.47 Gy (mean: 34.58 Gy) with a maximum mean dose of 43.99 Gy (range: 23.33 Gy-56.89 Gy). The prescribed isodose line ranged from 50.38%-85.68% with a mean of 79.25%. Treatment was delivered in 1-8 fractions (mean: 5.65). Patients were followed from 2-36 months (mean: 16.45 months). Overall median survival was 16 months with 55% of patients alive at 12 months and 34% of patients alive at 24 months. Median survival of patients in Recursive Partitioning Analysis (RPA) classes III or IV was 32 months versus 12 months for those in RPA class V. Median survival for patients who received gross total resection was 36 months versus 8 months for those who underwent subtotal resection or biopsy. The results of this study using CyberKnife stereotactic radiosurgery (SRS) and hypofractionated radiotherapy compared favorably to historic data using focal EBRT in newly diagnosed post surgical GBM patients. A larger prospective analysis that compares CyberKnife SRS and hypofractionated radiotherapy to focal EBRT is warranted.
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Affiliation(s)
- John D Lipani
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California.
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Proton magnetic resonance spectroscopic imaging in newly diagnosed glioblastoma: predictive value for the site of postradiotherapy relapse in a prospective longitudinal study. Int J Radiat Oncol Biol Phys 2008; 70:773-81. [PMID: 18262090 DOI: 10.1016/j.ijrobp.2007.10.039] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 10/26/2007] [Accepted: 10/30/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the association between magnetic resonance spectroscopic imaging (MRSI)-defined, metabolically abnormal tumor regions and subsequent sites of relapse in data from patients treated with radiotherapy (RT) in a prospective clinical trial. METHODS AND MATERIALS Twenty-three examinations were performed prospectively for 9 patients with newly diagnosed glioblastoma multiforme studied in a Phase I trial combining Tipifarnib and RT. The patients underwent magnetic resonance imaging (MRI) and MRSI before treatment and every 2 months until relapse. The MRSI data were categorized by the choline (Cho)/N-acetyl-aspartate (NAA) ratio (CNR) as a measure of spectroscopic abnormality. CNRs corresponding to T1 and T2 MRI for 1,207 voxels were evaluated before RT and at recurrence. RESULTS Before treatment, areas of CNR2 (CNR > or =2) represented 25% of the contrast-enhancing (T1CE) regions and 10% of abnormal T2 regions outside T1CE (HyperT2). The presence of CNR2 was often an early indicator of the site of relapse after therapy. In fact, 75% of the voxels within the T1CE+CNR2 before therapy continued to exhibit CNR2 at relapse, compared with 22% of the voxels within the T1CE with normal CNR (p < 0.05). The location of new contrast enhancement with CNR2 corresponded in 80% of the initial HyperT2+CNR2 vs. 20.7% of the HyperT2 voxels with normal CNR (p < 0.05). CONCLUSION Metabolically active regions represented a small percentage of pretreatment MRI abnormalities and were predictive for the site of post-RT relapse. The incorporation of MRSI data in the definition of RT target volumes for selective boosting may be a promising avenue leading to increased local control of glioblastomas.
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Chuang CF, Chan AA, Larson D, Verhey LJ, McDermott M, Nelson SJ, Pirzkall A. Potential value of MR spectroscopic imaging for the radiosurgical management of patients with recurrent high-grade gliomas. Technol Cancer Res Treat 2008; 6:375-82. [PMID: 17877425 DOI: 10.1177/153303460700600502] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous studies have shown that metabolic information provided by 3D Magnetic Resonance Spectroscopy Imaging (MRSI) could affect the definition of target volumes for radiation treatments (RT). This study aimed to (i) investigate the effect of incorporating spectroscopic volumes as determined by MRSI on target volume definition, patient selection eligibility, and dose prescription for stereotactic radiosurgery treatment planning; (ii) correlate the spatial extent of pre-SRS spectroscopic abnormality and treatment volumes with areas of focal recurrence as defined by changes in contrast enhancement; and (iii) examine the metabolic changes following SRS to assess treatment response. Twenty-six patients treated with Gamma Knife radiosurgery for recurrent glioblastoma multiforme (GBM) were retrospectively evaluated. All patients underwent both MRI and MRSI studies prior to SRS. Follow-up MRI exams were available for all 26 patients, with MRI/MRSI available in only 15/26 patients. We observed that the initial CNI 2 contours extended beyond the pre-SRS CE in 25/26 patients ranging in volume from 0.8 cc to 18.8 cc (median 5.6 cc). The inclusion of the volume of CNI 2 extending beyond the CE would have increased the SRS target volume by 5-165% (median 23.4%). This would have necessitated decreasing the SRS prescription dose in 19/26 patients to avoid increased toxicity; the resultant treatment volume would have exceeded 20cc in five patients, thus possibly excluding those from RS treatment per our institutional practice. MRSI follow-up studies showed a decrease in Choline, stable Creatine, and increased NAA indicative of response to SRS in the majority of patients. When combined with patient survival data, metabolic information obtained during follow-up MRSI studies seemed to indicate the potential to help to distinguish necrosis from new/recurrent tumor; however, this should be further verified by biopsy studies.
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Affiliation(s)
- Cynthia F Chuang
- Department of Radiation Oncology, University of California, San Francisco, Box 0226, San Francisco, CA 94143-0226, USA.
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Langer DL, Rakaric P, Kirilova A, Jaffray DA, Damyanovich AZ. Assessment of metabolite quantitation reproducibility in serial 3D-1H-MR spectroscopic imaging of human brain using stereotactic repositioning. Magn Reson Med 2007; 58:666-73. [PMID: 17899591 DOI: 10.1002/mrm.21351] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intrasubject reproducibility of metabolite quantitation in three-dimensional proton magnetic resonance spectroscopic imaging (3D-MRSI) was investigated in 10 healthy volunteers over five separate sessions using two echo times (TEs): 144 and 30 ms. The use of a Gill-Thomas-Cosman (GTC) stereotactic head frame enabled precise subject repositioning and immobilization. Metabolite levels from each voxel in the volume of interest (VOI) were quantified using the Linear Combination of Model spectra (LCModel) analysis algorithm, and coefficients of variation (CVs) were calculated. Standard error estimates (%SD or Cramer-Rao lower bounds) generated by LCModel were used as a confidence filter. The 95% confidence interval (CI) was found for each metabolite, providing an indication of the normal fluctuation expected for 3D-MRSI. In vivo, median CVs at the %SD < or = 20 level were found to be (%CV for TE = 144 and 30 ms, respectively): N-acetyl-aspartate plus N-acetyl-aspartyl-glutamate (NAA): 10.2% and 13.5%; creatine plus phosphocreatine (Cr), 14.4% and 21.7%; and choline-containing compounds (Cho), 15.2% and 18.4%. Relaxing the statistical filtering criteria to %SD < or = 30 increased median CVs by less than 5% and permitted in vivo quantitation reproducibility to be evaluated for glutamine plus glutamate (Glx) and myoinositol (Ins) for TE = 30 ms, yielding CVs of 24.0% and 21.0%, respectively.
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Affiliation(s)
- Deanna L Langer
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
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Payne GS, Leach MO. Applications of magnetic resonance spectroscopy in radiotherapy treatment planning. Br J Radiol 2006; 79 Spec No 1:S16-26. [PMID: 16980681 DOI: 10.1259/bjr/84072695] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Following advances in conformal radiotherapy, a key problem now facing radiation oncologists is target definition. While MRI and CT provide images of excellent spatial resolution, they do not always provide sufficient contrast to identify tumour extent or to identify regions of high cellular activity that might be targeted with boost doses. Magnetic resonance spectroscopy (MRS) is an alternative approach that holds great promise for aiding target definition for radiotherapy treatment planning, and for evaluation of response and recurrence. MRS is able to detect signals from low molecular weight metabolites such as choline and creatine that are present at concentrations of a few mM in tissue. Spectra may be acquired from single voxels, or from a 2D or 3D array of voxels using spectroscopic imaging. The current state of the art achieves a spatial resolution of 6-10 mm in a scan time of about 10-15 min. Co-registered MR images are acquired in the same examination. The method is currently under evaluation, in particular in brain (where MRS has been shown to differentiate between many tumour types and grades) and in prostate (where cancer may be distinguished from normal tissue and benign prostatic hypertrophy). The contrast achieved with MRS, based on tissue biochemistry, therefore provides a promising alternative for identifying tumour extent and regions of high metabolic activity. It is anticipated that MRS will become an essential tool for treatment planning where other modalities lack the necessary contrast.
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Affiliation(s)
- G S Payne
- Cancer Research UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research and Royal Marsden NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
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Abstract
This article reviews the use of MR in preclinical and clinical experiments to aid drug development. In particular it concentrates on the use of MR to study tumor microvasculature following treatment with anti-vascular agents and the use of MRS to study tumor metabolism following treatment with a variety of anti-cancer agents. The advantages and disadvantages of a variety of techniques including contrast- and noncontrast-enhanced methods are discussed and the data from clinical trials using these techniques are reviewed. Despite the consensus documents produced to date for both dynamic contrast-enhanced MRI and MRS, most of the trials reported used alternative methods, and different nomenclature for the MR parameters used. This continues to inhibit the comparison between novel therapeutics and between different trials with the same compound. Comprehensive data from multicenter trials on the reproducibility of techniques is still lacking in the literature and the implications of the available data on clinical trial design is also discussed.
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Affiliation(s)
- Susan M Galbraith
- Clinical Discovery, Bristol-Myers Squibb, Princeton, NJ 08453-4000, USA.
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Lin AP, Tran TT, Ross BD. Impact of evidence-based medicine on magnetic resonance spectroscopy. NMR IN BIOMEDICINE 2006; 19:476-83. [PMID: 16763969 DOI: 10.1002/nbm.1058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Magnetic resonance spectroscopy (MRS) is a robust, non-invasive means of defining aspects of human neurochemistry. After more than two decades, it is clear that in addition to its scientific interest, MRS has diagnostic value in tumor diagnosis, prognosis, therapeutic outcome, dementia diagnosis and prognosis, multiple sclerosis, infections, trauma, development, stroke, perinatal ischemia, xenobiotics and inborn errors (as determined from a meta-analysis included in this paper). However, in many healthcare systems, a new radiological technique requires evidence-based medicine (EBM) before it is recommended for reimbursement. Much of the reason why MRS is thought to be non-reimbursable in the USA is due to recent announcements that this 15-year-old technique is still considered 'investigational' by these EBM assessments. An analysis is presented of the technology assessments that brought about this situation. Based on the conclusions of the EBM assessments, strategies are suggested that involve all entities responsible for spectroscopy including the scientists' role in ensuring the future for clinical spectroscopy.
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Affiliation(s)
- Alexander P Lin
- Rudi Schulte Research Institute, Santa Barbara, CA 93130, USA
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Cao Y, Sundgren PC, Tsien CI, Chenevert TT, Junck L. Physiologic and Metabolic Magnetic Resonance Imaging in Gliomas. J Clin Oncol 2006; 24:1228-35. [PMID: 16525177 DOI: 10.1200/jco.2005.04.7233] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Magnetic resonance (MR) imaging provides excellent soft tissue differentiation and in vivo assessment of physiologic and metabolic properties of tissue. As new and more aggressive treatment modalities and combined modalities are being investigated for brain tumor treatment, it is becoming more important to accurately define tumor volumes for treatment planning, to determine the most aggressive tumor regions for intensified radiation treatment, to identify early regional response to therapy for reoptimization of treatment, and to detect early indicators of developing normal tissue toxicity. Readily available MR techniques of physiologic and metabolic imaging can currently provide useful information regarding tumor tissue properties including chemical composition, cerebral blood volume, perfusion, vascular permeability, and water mobility. This article will focus on the potential value of MR physiologic and metabolic imaging in the clinical management of malignant gliomas.
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Affiliation(s)
- Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109-0010, USA.
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Lemaire JJ, Khalil T, Bard JJ, Verrelle P. Place de la radiochirurgie dans le traitement des oligodendrogliomes. Neurochirurgie 2005; 51:393-9. [PMID: 16292181 DOI: 10.1016/s0028-3770(05)83498-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Radiosurgery of oligodendrogliomas is not specific. It must be integrated into the overall treatment scheme for gliomas which remains to be strictly defined. Nevertheless, empirically, and in light of the limited constraints for the patient and the encouraging radiological and clinical benefits, radiosurgical teams usually propose this technique in the event of recurrence of malignant gliomas, as a second line treatment. Exceptionally radiation can be used for some small benign gliomas which could not be treated by open surgery and accurately defined radiologically. Radiosurgery can achieve local control of the lesion, mostly transitionally, with 15 to 18 Gy at the reference isodose. One of the key problems is the definition of the glioma boundaries. Despite progress in neuroimaging techniques most the limits of malignant forms are still not accessible. In routine practice, the nodular area, considered as the most active on MRI, i.e. the contrast enhanced area, is accepted as the target. Its widest dimension must be about 35-40 mm. Only patients with minimal disability can benefit from radiosurgery. Optimization of the target definition (in particular the most active zone) and prospective randomized studies should be helpful in clarifying indications for this technique.
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Affiliation(s)
- J-J Lemaire
- Service de Neurochirurgie A, CHU, Clermont-Ferrand.
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Abstract
Imaging in patients with brain tumors aims toward the determination of the localization, extend, type, and malignancy of the tumor. Imaging is being used for primary diagnosis, planning of treatment including placement of stereotaxic biopsy, resection, radiation, guided application of experimental therapeutics, and delineation of tumor from functionally important neuronal tissue. After treatment, imaging is being used to quantify the treatment response and the extent of residual tumor. At follow-up, imaging helps to determine tumor progression and to differentiate recurrent tumor growth from treatment-induced tissue changes, such as radiation necrosis. A variety of complementary imaging methods are currently being used to obtain all the information necessary to achieve the above mentioned goals. Computed tomography and magnetic resonance imaging (MRI) reveal mostly anatomical information on the tumor, whereas magnetic resonance spectroscopy and positron emission tomography (PET) give important information on the metabolic state and molecular events within the tumor. Functional MRI and functional PET, in combination with electrophysiological methods like transcranial magnetic stimulation, are being used to delineate functionally important neuronal tissue, which has to be preserved from treatment-induced damage, as well as to gather information on tumor-induced brain plasticity. In addition, optical imaging devices have been implemented in the past few years for the development of new therapeutics, especially in experimental glioma models. In summary, imaging in patients with brain tumors plays a central role in the management of the disease and in the development of improved imaging-guided therapies.
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Affiliation(s)
- Andreas H Jacobs
- Max Planck-Institute for Neurological Research, Cologne, Germany.
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Lin A, Ross BD, Harris K, Wong W. Efficacy of proton magnetic resonance spectroscopy in neurological diagnosis and neurotherapeutic decision making. NeuroRx 2005; 2:197-214. [PMID: 15897945 PMCID: PMC1064986 DOI: 10.1602/neurorx.2.2.197] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Anatomic and functional neuroimaging with magnetic resonance imaging (MRI) includes the technology more widely known as magnetic resonance spectroscopy (MRS). Now a routine automated "add-on" to all clinical magnetic resonance scanners, MRS, which assays regional neurochemical health and disease, is therefore the most accessible diagnostic tool for clinical management of neurometabolic disorders. Furthermore, the noninvasive nature of this technique makes it an ideal tool for therapeutic monitoring of disease and neurotherapeutic decision making. Among the more than 100 brain disorders that fall within this broad category, MRS contributes decisively to clinical decision making in a smaller but growing number. In this review, we will cover how MRS provides therapeutic impact in brain tumors, metabolic disorders such as adrenoleukodystrophy and Canavan's disease, Alzheimer's disease, hypoxia, secondary to trauma or ischemia, human immunodeficiency virus dementia and lesions, as well as systemic disease such as hepatic and renal failure. Together, these eight indications for MRS apply to a majority of all cases seen. This review, which examines the role of MRS in enhancing routine neurological practice and treatment concludes: 1) there is added value from MRS where MRI is positive; 2) there is unique decision-making information in MRS when MRI is negative; and 3) MRS usefully informs decision making in neurotherapeutics. Additional efficacy studies could extend the range of this capability.
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Affiliation(s)
- Alexander Lin
- Rudi Schulte Research Institute, Santa Barbara, California 93105, USA
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Nelson SJ. Magnetic resonance spectroscopic imaging. Evaluating responses to therapy for gliomas. ACTA ACUST UNITED AC 2005; 23:30-9. [PMID: 15565797 DOI: 10.1109/memb.2004.1360406] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sarah J Nelson
- Department of Radiology, University of California, San Francisco 94143-0775, USA.
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